The Development of state-wide clinical sites: A perspective

The Development of State-The Development of State-Wide Clinical Internships in an Wide Clinical Internships in an

Athletic Training Education Athletic Training Education Program: A PerspectiveProgram: A Perspective

CCC Teaching & Learning ConferenceCCC Teaching & Learning Conference August 16August 16thth,2007,2007

Steve Cernohous, EdD, ATC, LATSteve Cernohous, EdD, ATC, LATAssistant Professor / Clinical Coordinator Assistant Professor / Clinical Coordinator

Athletic Training Education ProgramAthletic Training Education Program

Today’s AgendaToday’s Agenda

● ● Clinical Education DefinedClinical Education Defined● ● Clinical Site DevelopmentClinical Site Development● ● Various SettingsVarious Settings● ● The Approved Clinical InstructorThe Approved Clinical Instructor● ● The StudentThe Student● ● Training & DevelopmentTraining & Development● ● ChallengesChallenges

DefinitionDefinition

● ● A method in which theory and skills can A method in which theory and skills can move from the classroom to “real world”move from the classroom to “real world”● ● Culture & professional values are passed Culture & professional values are passed on to studentson to students● ● The quality of these experiences has a The quality of these experiences has a significant impact on the quality of the significant impact on the quality of the professional producedprofessional produced

Jarski, RW; Kulig, K; & Olsen, RE (1990)Weidner, TG; & Angust, J (1997)Weidner, TG; & Henning, JM (2002)

Clinical Site DevelopmentClinical Site Development

● ● Identifying the RIGHT environmentIdentifying the RIGHT environment● ● Numerous optionsNumerous options● ● BalanceBalance● ● Contract and ObligationContract and Obligation

Clinical SettingsClinical Settings● ● Athletic Training Room Athletic Training Room

- College / Community college- College / Community college- High School- High School- Professional Sports Team- Professional Sports Team

● ● Sports Medicine ClinicSports Medicine Clinic● ● Industrial SettingIndustrial Setting

- Fortune 500 companies- Fortune 500 companies● ● OtherOther

- Hospital – Health Center- Hospital – Health Center- Orthopedic Clinic- Orthopedic Clinic- Physical Therapy Clinic- Physical Therapy Clinic

Approved Clinical InstructorApproved Clinical Instructor

● ● Provides formal instruction and/or evaluation of students in the Provides formal instruction and/or evaluation of students in the clinical proficiencies…perform psychomotor and/or clinical proficiency clinical proficiencies…perform psychomotor and/or clinical proficiency instruction and evaluationinstruction and evaluation● ● Evaluation of the proficiency shall be done on a one-to-one basisEvaluation of the proficiency shall be done on a one-to-one basis● ● Must be BOC certified for at least 1 year and complete ACI trainingMust be BOC certified for at least 1 year and complete ACI training● ● Supervised clinical experiences shall involve daily personal contact Supervised clinical experiences shall involve daily personal contact and supervision between the clinical instructor and the student…The and supervision between the clinical instructor and the student…The instructor shall be physically present in order to intervene on behalf of instructor shall be physically present in order to intervene on behalf of the individual being treatedthe individual being treated

Foster, DT; Leslie, DK (1992)Weidner, TG; & Henning, JM (2002)

The StudentThe Student

● ● CLINICAL EDUCATIONCLINICAL EDUCATION● ● FIELD EXPERIENCEFIELD EXPERIENCE● ● FIRST RESPONDERFIRST RESPONDER

Gray, A; Smith, T (2000)

Training & DevelopmentTraining & Development

● ● Initial ACI 5 hour training conducted by CIEInitial ACI 5 hour training conducted by CIE● ● Follow up training done every 3 yearsFollow up training done every 3 years● ● Evaluations of ACIs done annually by Clinical CoordinatorEvaluations of ACIs done annually by Clinical Coordinator● ● Evaluations done by each student at the end of the termEvaluations done by each student at the end of the term

ChallengesChallenges

● ● RolesRoles● ● Supervision – Direct and GradedSupervision – Direct and Graded● ● FeedbackFeedback● ● CommunicationCommunication● ● Conflict resolutionConflict resolution● “● “Work ethic”Work ethic”● ● Patient CarePatient Care

Nolan (1998)Pitney, W; & Parker, J (2003)Carr, WD; & Drummond, JL (2002)Weidner, TG; & Henning, JM (2002)


● ● EvaluationsEvaluations● ● TeachingTeaching● ● Role StrainRole Strain● ● AcceptanceAcceptance● ● Theory-Application GapTheory-Application Gap● ● Goal settingGoal setting

Nolan (1998)Pitney, W; & Parker, J (2003)Carr, WD; & Drummond, JL (2002)Weidner, TG; & Henning, JM (2002)


● ● Supervision – DirectSupervision – Direct- Must have constant supervision and auditory - Must have constant supervision and auditory interaction with ACIinteraction with ACI→ → Proficiency evaluation must be re-evaluated by ACI Proficiency evaluation must be re-evaluated by ACI to determine student’s ability to apply the skills clinicallyto determine student’s ability to apply the skills clinically →→ Students must obtain at least 75% of their clinical Students must obtain at least 75% of their clinical education experience under the direct supervision of education experience under the direct supervision of

an ACI or CI who is an ATCan ACI or CI who is an ATC →→ The ATS is still encouraged to make independent The ATS is still encouraged to make independent

clinical decisionsclinical decisions


● ● Supervision –GradedSupervision –Graded

→ → Once a student demonstrates proficiency and Once a student demonstrates proficiency and some experience with a particular skill, that student some experience with a particular skill, that student should be granted supervised autonomyshould be granted supervised autonomy (i.e. (i.e. permitted to initiate actions, perform initial permitted to initiate actions, perform initial evaluations, and develop and implement evaluations, and develop and implement rehabilitation programs with the rehabilitation programs with the clinical instructor in clinical instructor in the same room/field where he/she can see and hear the same room/field where he/she can see and hear the studentthe student, but not necessarily looking over the , but not necessarily looking over the student’s shoulder)student’s shoulder)


● ● FeedbackFeedback- vital- vital- regular- regular- objective- objective- positive- positive


● ● CommunicationCommunication- - well-established well-established

- approachable - approachable - non-confrontational- non-confrontational


● ● Conflict resolutionConflict resolution- immediate- immediate- consistent- consistent- guidelines- guidelines


● “● “Work Ethic”Work Ethic”- misunderstood- misunderstood- clinical experience - clinical experience - hours- hours


● ● Patient CarePatient Care- primary- primary- expectations- expectations- liability- liability


● ● EvaluationsEvaluations- daily- daily- formative- formative- self- self


● ● TeachingTeaching- didactic curriculum- didactic curriculum- symbiotic- symbiotic- methodology- methodology


● ● Role StrainRole Strain- obligations- obligations- ambiguity- ambiguity- conflict- conflict- incompetence- incompetence

Weidner, TG; & Henning, JM (2002)


● ● AcceptanceAcceptance- culture- culture- role- role- own identity- own identity


● ● Theory-Application GapTheory-Application Gap- consistent- consistent- variety of settings- variety of settings- collaboration- collaboration

Carr, WD; & Drummond, JL (2002)


● ● Goal SettingGoal Setting- well defined- well defined- accountable- accountable- partnership- partnership- attainable- attainable

Questions ?Questions ?

THANK YOUTHANK YOU

Health & Medicine

The Development of state-wide clinical sites: A perspective